'We need to reinvent the health care system': Independent Health expands Care for You program

Jan. 11—IH says program has reduced hospitalizations

Working in the emergency department over the years, there have been times when Dr. Anthony J. Billittier IV has grown frustrated with the nation's health care system.

He sees a system that isn't customer focused and isn't delivering care the way patients want it — and certainly isn't always providing the right care at the right time in the right place. Emergency departments are busy, he notes, because they're often the most accessible option — open 24/7, with no appointment required.

Seeing a system in need of change is why Billittier is excited with the growth Independent Health has seen with its Care for You program, which launched in late 2021 and brings health care directly into the home of the health plan's Medicare Advantage members with chronically complex medical conditions.

Billittier, chief medical officer of Independent Health, said the program has helped keep members out of the hospital, allowing them to receive care at home and stay healthier while also lowering costs and decompressing overburdened hospitals.

And the program — similar to ones offered by Highmark Blue Cross Blue Shield of Western New York and Univera Healthcare — has now launched for Medicaid members and is eyeing entering the health plan's commercial line of business soon.

"We need to reinvent the health care system," Billittier said. "So I think that's what you're seeing here. And I think as a nation, you're going to see more and more of this sort of alternate care, without bricks and mortar, continue to expand because it has to.

"This is really just the start of the next wave. It has to be."

How is it going?

Independent Health officials said the Care for You program is performing better than expected — in more ways than one.

The health plan now has more than 2,200 Medicare members enrolled in the program, exceeding its forecast of 1,800 members by the end of the first year.

And members enrolled in the program are staying out of the hospital more often.

Specifically, preventable admissions are down by 54%, while readmissions have declined by 45%. Further, emergency room visits were reduced by 23%, while all inpatient hospital stays have dropped by 33%.

"We've had a big impact," said Mike Reilly, senior vice president and chief healthcare innovation and strategy officer at Independent Health. "This is really about treating the patient in a way that they want to be treated, and they don't want to go to the hospital."

From May through December, Reilly said, Independent Health received more than 80 unsolicited phone calls, emails or letters with positive feedback about the program. Over the course of the whole year, he said, they've had just nine complaints.

Hiring success

Independent Health formed an affiliated company to launch the Care for You program.

It created WNY Coordinated Medical Care, which is a team of physicians, nurse practitioners, nurses, pharmacists and other professionals who work with primary care doctors to manage health care for members in the Care for You program.

Reilly said WNY Coordinated Medical Care has grown to 70 employees. He said Independent Health has found success in hiring, partly because he believes this patient-centric care is what many health care professionals want to provide.

"Everybody's complaining about staffing issues," Reilly said. "We have over 30 nurses in the program, and no difficulty recruiting because this is the kind of care everybody wants to provide. And where did the nurses come from? They came from everywhere. They came from hospitals. They came from home care. They came from hospice."

What's next?

When Independent Health launched the program in late 2021, it had identified about 6,000 members — or about 10% of its total Medicare Advantage membership — with three to five chronic conditions who would be a good fit for Care for You.

Reilly believes more than 4,000 members could be in the program by the end of 2023.

And Independent Health in December launched the program for its Medicaid members and has started enrolling people. In accordance with that launch, the health plan also hired two more social workers.

Initially, Reilly said the health plan has identified about 600 Medicaid members who could be a good fit for the program.

Independent Health also plans to bring the Care for You program to its commercial line of business, possibly sometime in February.

"We're going to be in all lines of business here at the end of the first quarter," Reilly said.

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